We undertook a retrospective comparative study
of all patients with an unstable slipped capital femoral epiphysis presenting
to a single centre between 1998 and 2011. There were 45 patients
(46 hips; mean age 12.6 years; 9 to 14); 16 hips underwent intracapsular
cuneiform osteotomy and 30 underwent pinning Pinning Non-emergency intracapsular osteotomy may have a protective effect
on the epiphyseal vasculature and should be undertaken with a delay
of at least two weeks. The place of emergency pinning Cite this article:
The aim of this study was to validate the SENIAM recommendations for surface electromyography placement(sEMG) over rectus femoris(RF) muscle in healthy children and in children with cerebral palsy(CP) during gait analysis and compare placement using these guidelines to using ultrasonography. The study included 10 healthy children volunteers and 10 CP children volunteers, aged 8–12. All the CP children had spastic diplegia, were GMFCS levels I–II and had not previously undergone surgery. RF electrodes were placed following SENIAM recommendations. RF was then identified by ultrasound. The distance between the lateral edge of RF and the position of the sEMG electrode as per SENIAM guidelines and the width of RF was measured, to the nearest millimetre. We considered ‘ideal electrode’ position to be at halfway between the edges of RF (i.e. 50%). The mean percentage difference in distance from the ‘ideal electrode’ position as measured by ultrasound to electrode placement following SEMIAN guidelines was 2.7% in the healthy children group compared with 19.5% in the CP group. By performing unpaired SENIAM recommendations for sEMG electrode placement over RF muscle were validated in 10 healthy children. We showed that ultrasonography improved the accuracy of sEMG electrode placement in children with CP, who can exhibit anatomical variation due to their condition. Accurate electrode placement will ensure that a more accurate signal is recorded which may have a direct clinical bearing on the decision to proceed with surgical intervention. Level of evidence: IIMethods & Results:
Conclusion:
The aim of this retrospective study was to review the outcome of patients treated with Fassier-Duval (FD) rods and highlight some of the complications found during treatment. Between April 2006 and August 2010 we inserted 24 FD rods in 13 patients. 17 rods for osteogenesis imperfecta (OI), 2 for fractures and deformity associated with cerebral palsy, 1 for fracture associated with muscular dystrophy, 1 for fibrous dysplasia and 3 for centralisation of single bone forearms. In the upper limb one patient required revision for proximal migration of the male component and another patient is waiting for revision for the same problem. In the lower limb, a tibial nail was revised because of proximal migration of the male component. A femoral nail was adjusted because of loss of the proximal fixation. One of the OI patients fell, fractured the femur and bent a femoral nail. This awaits revision at a later date. A second OI patient fell on 2 separate occasions bending both a tibial and a femoral nail respectively. These were both revised to trigen intramedullary nails. In all the other cases there were no complications. In summary the Fassier Duval system provides a versatile way of providing intramedullary stabilisation for growing bones through a single entry point. However in our experience we have a 33% complication rate most notably bending of the rods. We advocate careful patient selection and using as high a diameter nail as is feasible.
We report our initial experience of using the Ponseti method for the treatment of congenital idiopathic club foot. Between November 2002 and November 2004 we treated 100 feet in 66 children by this method. The standard protocol described by Ponseti was used except that, when necessary, percutaneous tenotomy of tendo Achillis were performed under general anaesthesia in the operating theatre and not under local anaesthesia in the out-patient department. The Pirani score was used for assessment and the mean follow-up time was 18 months (6 to 30). The results were also assessed in terms of the number of casts applied, the need for tenotomy of tendo Achillis and recurrence of the deformity. Tenotomy was required in 85 of the 100 feet. There was a failure to respond to the initial regimen in four feet which then required extensive soft-tissue release. Of the 96 feet which responded to initial casting, 31 (32%) had a recurrence, 16 of which were successfully treated by repeat casting and/or tenotomy and/or transfer of the tendon of tibialis anterior. The remaining 15 required extensive soft-tissue release. Poor compliance with the foot-abduction orthoses (Denis Browne splint) was thought to be the main cause of failure in these patients.
